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<title>赴日就医治疗问诊表</title>
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<body style="background-color: white">
<!--// 导航条-->
<div style="width: 100%;height: 45px;line-height: 45px;background-color: #38a16d;position: fixed;z-index: 10000">
    <h1 class="nav-title" style="font-size: 18px;">赴日就医治疗问诊表</h1>
    <img src="../img/BackIcon.png" alt="返回" class="nav-backImg" id="back"/>
</div>
<div class="useInfor" style="padding-top: 45px">
    <div class="tit">
        <img src="../img/icon-medical.png" />
        <p>个人信息</p>
    </div>
    <div class="con">
        <dl class="name">
            <dt>姓名</dt>
            <dd><input id="name" type="text" placeholder="请输入您的姓名"></dd>
        </dl>
        <dl class="six">
            <dt>性别</dt>
            <dd>
                <div class="man">
                    <input type="radio" id="man" name="sex">
                    <p>男</p>
                </div>
                <div class="woman">
                    <input type="radio" id="woman" name="sex">
                    <p>女</p>
                </div>
            </dd>
        </dl>
        <dl class="birthday">
            <dt>生日</dt>
            <dd><input type="text" id="birthday" placeholder="如2015-7-5"></dd>
        </dl>
        <dl class="phone">
            <dt>电话</dt>
            <dd><input type="text" id="phone" placeholder="输入患者本人电话"></dd>
        </dl>
        <dl class="address">
            <dt>家庭住址</dt>
            <dd><input type="text" id="address" placeholder="输入患者本人住址"></dd>
        </dl>
    </div>
    <div class="next_step" id="next_step">下一步</div>
</div>
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